Korean J Radiol.  2016 Aug;17(4):545-553. 10.3348/kjr.2016.17.4.545.

Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

• Kim YK
• Kim JS
• Lee KW
• Yi CA
• Koo JM
• Jung SH

• KMID: 2455425
• DOI: http://doi.org/10.3348/kjr.2016.17.4.545

Abstract

OBJECTIVE
To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD).
MATERIALS AND METHODS
The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque.
RESULTS
Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD.
CONCLUSION
Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.

Keyword

Mesothelioma; Metastasis; CT; Pleura

MeSH Terms

Adult
Aged
Diagnosis, Differential
Female
Humans
Image-Guided Biopsy
Lung Neoplasms/*diagnosis/diagnostic imaging/pathology/secondary
Lymphatic Metastasis
Male
Mesothelioma/*diagnosis/diagnostic imaging/pathology
Middle Aged
*Multidetector Computed Tomography
Odds Ratio
Pleural Neoplasms/*diagnosis/diagnostic imaging/pathology
Republic of Korea
Retrospective Studies

Figure

• 

  Fig. 1 CT findings of MPM and MPD. A, B. 48-year-old woman with epithelioid type MPM. Circumferential pleural thickening and fissural pleural thickening (arrows) involving right hemithorax. C, D. 82-year-old woman with MPD from renal cell carcinoma. Nodular pleural thickeing involving both hemithorax and hematogenous metastases in both lungs. CT = computed tomography, MPD = metastatic pleural disease, MPM = malignant pleural mesothelioma

• 

  Fig. 2 63-year-old woman with bilateral MPM involving pericardium and both diaphragmatic pleura. Transverse CT images (A, B) and coronal reformatted image (C) show bilateral pleural effusion, pericardial thickening (arrows) and thickening of both diaphragmatic pleura. MPM = malignant pleural mesothelioma

• 

  Fig. 3 71-year-old man with MPM. Transverse CT images show circumferential pleural thickening in right hemithorax. Note calcified pleural plaques in both hemithorax (arrows). CT = computed tomography, MPM = malignant pleural mesothelioma

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